Mental Health Stigmas
My focus here is challenging the notion that a person has to be in crisis or “sick” to need mental health therapy. In truth, most of my clients don’t have a significant illness. They made their first appointment because they felt stuck.
They had conflict with a partner.
They were struggling with work.
They were confused about how to navigate an important decision.
Or they were feeling overwhelmed by a buildup of stress.
These are normal life experiences for all of us and don’t equate to being sick. Because someone doesn’t have all of the answers doesn’t make them deficient or inadequate. Athletes have coaches. Investors have financial advisors. People go to others for help for all sorts of reasons. In our culture, having a professional on your side is seen as a strength, a commodity. Why should therapy be any different?
There are many times in life where our best thinking just isn’t enough. I’ve worked with doctors, lawyers, and other high functioning professionals who certainly aren’t lacking in their ability to problem solve and accomplish difficult tasks. Indeed, for years I’ve worked with hundreds of smart, competent, and capable adults. The common denominator for being in mental health therapy is that they feel overwhelmed by their emotions. They need help making sense of their feelings to make decisions that allow them to feel better and move forward.
Fight or Flight
Everyone experiences a range of emotions. While some people are thoughtful, measured, and regulated in the way they express their feelings, others are more reactive and hot tempered. And these two personality types often fluctuate to the other extreme based on environmental and social stressors they’re facing. But it is important to note that regardless of a person’s level of intelligence and their emotional temperament, emotions have a basic function for everyone.
Emotions provide a safety reaction in the same way an animal reacts when in the presence of prey: the fight-or-flight response. It is an instinctual mechanism compelling immediate action ensuring survival. People have the same fight-or-flight response to physical threats. In these situations, the amygdala (a function of the brain that processes emotions) overrides the prefrontal cortex (the part of the brain that processes complex behaviors including planning). The logical, decision making part of the brain is hijacked in a very functional way, since there would be grave consequences if we took time to consider whether there is or isn’t a threat, contemplate the best decision, and act accordingly.
Danger
However, unlike animals, people have the same fight-or-flight response to emotional danger. A response that is just as strong.
But physical and emotional danger are not transactional. Physical threats are usually unmistakable; there is no question about whether one is present. As a result, emotionally driven compulsions to react without thought serves people well. In a Darwinian sense, it preserves us as humans.
Emotional danger is much more problematic because it is relative to person, place, time, and situation. It is entirely subjective. Additionally, the way in which emotional danger is perceived is influenced by past experiences. Environment, natural disposition, and other resiliencies, which are different for everyone, feed into those perceptions. Even more problematic is that experiences that caused emotional harm in the past are often wrongly attached, or linked, to present experiences that pose no real threat. The result is misinterpreting emotional danger to be present where none exists.
With a kind of deceitfulness, emotions cause disproportionately intense fight-or-flight reactions in situations that require clear thinking and thoughtful responses. Rather than being protective and adaptive they are misleading and cause unnecessary distress.
Bracing for Impact
Intense emotional reactions in situations where they don’t belong presents barriers to coping with many parts of life. They negatively impact work, academic, family, and social capacities. Common examples I hear from clients include anxiety or panic attacks at times when clear thinking and regulated behavior are necessary – situations where no real threat is present. Being short or easily frustrated with a partner when discussing certain issues. Experiencing strong feelings of fear or mistrust when interacting with a particular gender or in a specific setting. Additionally, the inaccurate interpretation of emotional danger increases cortisol production (the stress hormone) and causes chronic hyperarousal, causing stress and feelings of overwhelm.
This process of perception is often a central contributor to why people feel stuck and unfulfilled. But the good news is that it is also a process that is reprogrammable. As I often tell my clients, we can “update our operating system”, and learn to interpret our emotions in more accurate and adaptive
Update your OS
Unless acute or complex trauma is causing severe symptoms and functional impairment, where an approach such as Eye Movement Desensitization and Reprocessing (EMDR) might be more appropriate to start, Cognitive Behavioral Therapy (CBT) is the most common and effective technique to change how thoughts are applied to feelings and, in turn, lessen the adverse impact emotions cause. But, as I have insisted in other essays, relationship and rapport must come first for any technique to be helpful. There is a mandate to feel safe, understood, valued, and supported before relying on any therapists’ experience and proficiency with a particular approach.
Managing emotions in new ways is difficult since they are powerful and convincing. They sometimes feel permanent and cause forceful, automatic reactions. It is also important to remember that the existing operating system of interpreting emotions has been “installed” for most of a lifetime. That being said, management first involves fully appreciating their protective function. With this new meta perspective and a self-compassionate foundation, the process of change involves identifying the language being used to interpret emotions. This entails modifying a negative filter. A filter that induced a cycle of feeling bad about feeling bad. Once this cycle began, momentum only grew, with each exposure to an emotion causing stronger reactions over time.
Tools
Identifying the language used to filter emotions permits more accurate reinterpretations. Moreover, insight progresses with regard to how those outdated first experiences are being miss-linked to present situations. This facilitates an opportunity to start applying thoughtful and regulated responses to strong emotions. A kind of in vivo training exercise.
Another approach uses visualization techniques, invoking the same intense physiological symptoms caused by a specific situation or event without experiencing it directly. With visualization, more adaptive responses can be developed using a modified filter. Additional assignments may include daily journaling, keeping a thought-record, and mood charting. They are formulated during session based on the individual, and may include a partner’s participation when appropriate.
Diligence to specific, often daily work outside of the therapy setting is necessary, where much of the unlearning and reprocessing is accomplished. It is no coincidence that routine practice in real life is important, since this is where change is desired. With consistent effort, more desirable responses or, behaviors, while experiencing strong emotions leads to feeling better, a sign of becoming unstuck. To use local terminology, it is better to be at the helm rather than the bunkhouse of emotions. To navigate atop their waves instead of getting tossed around in the breakers. It is a process that requires an explorative attitude, being open to self-reflection, and authenticity. It is not always easy work, but the net gain is a skill that retains a lifetime value for everyone who invests in it.